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`J <br />Try- IF"A <br />_J <br />City of Roseville <br />Finance Department, License Division <br />2660, Civic Center Drive, I Roseville, MN 55113 <br />(651) 792-7034 <br />ri VIT <br />Im. 1111031111 <br />Email Address <br />Person to, Contact in Regard to Business License: <br />1 .01 <br />Legal Nam k <br />�e e,,A-e- I jrv�f,&!s <br />Address %W. r %W 0' 0 "r '%,Jl <br />Phone Date of Birth, <br />Drivers License Numbei <br />- <br />M <br />I hereby apply for the following license(s) for the term of one year,, beginning July 1, and ending <br />June 31 in the City of Roseville, County of Ramsey, and State of Minnesota. <br />,License Re <br />Massage Therapy Establishment <br />'Fee <br />$300.00 <br />150.00 Background Check <br />(new license only) <br />.� z <br />The unders,ig,ned applicant makes, this application pursuant to all the laws of the State of Minnesota and regulation <br />as the Council of the City of Roseville may from time to time prescribe, including Minnesota Statue #176.182, In <br />addition, the applicant acknowledges that thou are responsible for reviewing the background and work history of <br />their ernployiees, including those that have received a massage therapist license from. the City., <br />Signature i Ae <br />Date 6 , Fg1W <br />If completed license should be mailed somewhere other than the business address, please advise, <br />